R4: Validity of the CARE Tool Cognitive Items for Persons with Stroke, SCI and TBI

Overview

Why is this study needed?

The Deficit Reduction Act of 2005 mandated the development of a standardized patient assessment instrument by the Centers for Medicare and Medicaid Services (CMS). The Continuity and Record Evaluation (CARE) tool is a patient assessment instrument that has been developed to document the medical, cognitive, functional and discharge status of Medicare beneficiaries receiving health care services provided by short-term (acute care) hospitals, inpatient rehabilitation facilities, skilled nursing facilities, long-term care hospitals and home health agencies. Data from the new instrument will be used by Medicare to determine provider reimbursement (prospective payment rates), document provider-level quality of care (patient outcomes), and characterize the clinical complexity of patients.

Given the proposed uses of the CARE tool and the range of patients it will be applied to, it is important to examine the validity of these items for specific rehabilitation populations and understand what sub domains of cognition are measured on the CARE tool.

How will this study help patients and rehabilitation stakeholders?

This project uses the rich data collected in project R2 to examine the validity of new cognition items being tested by Medicare for use in a national Patient Assessment Instrument, the CARE tool. This project offers NIDRR an interagency collaboration opportunity with CMS that would help document the needs and outcomes of persons with cognitive limitations.

Objective 3: Identify cognitive items that would complement the CARE tool items for patients with stroke and patients with TBI.

How will the project objectives be achieved?

Cognition items from the CARE tool will be administered to the same population as the R2 project (stroke, SCI, and TBI). Correlations will be computed between these cognition items and "gold standard instruments." The pattern of correlation coefficients will demonstrate convergent and discriminant validity. We will also evaluate relationships between the CARE tool cognition items and self-reported cognitive function for individuals who demonstrate awareness of deficits.